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Category Archives: FOOD ALLERGIES

New Treatment for Peanut Allergy

There is some exciting news for children and their families with a history of peanut allergies. On September 13, 2019, the Allergenic Products Advisory Committee of the Food and Drug Administration (FDA) voted to recommend approval of a new oral immunotherapy product for children with peanut allergy.

Peanut is one of the most common foods that can be allergenic in children. It is also responsible for more severe and occasionally life-threatening reactions in highly sensitive children and adults. Adding to the concerns, in the U.S., peanut allergy in children has increased 21% since 2010, and nearly 2.5% of U.S. children may have an allergy to peanuts.

The current standard of care for the treatment of food allergies is the avoidance of the allergen (e.g., peanut) in conjunction with the treatment of anaphylaxis with self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q, and/or Adrenaclick). It should be noted that parents of children with severe sensitivity to peanut live with constant fear of a life-threatening reaction triggered by an accidental exposure to peanut products.

Oral immunotherapy (OIT) refers to feeding an allergic individual an increasing amount of an allergen with the goal of increasing the threshold that triggers a reaction. The procedure entails feeding the allergenic food to the child, beginning with an extremely small dose and gradually increasing the dose at regular intervals while closely monitoring for adverse reactions. This must be done by in a hospital or in an allergist’s office where the allergist and staff are prepared to treat an adverse reaction without delay. The “escalation” of doses, as mentioned above, is typically performed in an allergist’s office, which is equipped to monitor and treat potential reactions whereas maintenance doses can be given at home.

“Desensitization” refers to the improvement in food challenge outcomes after therapy and relies on ongoing exposure to the allergen. If successfully accomplished, desensitization has the potential to substantially reduce the risk of a severe reaction following accidental exposure to the allergen and would hopefully minimize the anxiety of parents. This form of treatment also requires regular exposure to the food indefinitely in order to maintain the “desensitized” or “tolerant” state. OIT with peanut is unlikely to induce “sustained unresponsiveness” which refers to the retention of the protective benefit achieved through therapy. This sustained unresponsiveness is not reliant on the ongoing exposure to peanut.

The possible side effects of OIT include symptoms limited to the gastrointestinal tract such as itching of the mouth and/or lips, abdominal cramping, and diarrhea. Rarely more severe systemic reactions such as generalized hives (i.e., urticaria), swelling of tongue and/or throat (i.e., angioedema), difficulty in swallowing, shortness of breath, wheezing, and drop in blood pressure may occur.

The FDA has not yet approved the new treatment but they are likely to approve it soon based on the recommendations of its Allergenic Products Advisory Committee. “Palforzia” will be the brand name of the new drug, which is a powder containing 12 peanut proteins (Ara h 1, Ara h 2, Ara h 3, etc.) thought to be the principal allergens in peanuts. The letters of the terminology, Ara h, correspond to the genus and species of the peanut plant, Arachis hypogaea, and the number (1, 2, 3, etc.) distinguishes each discrete protein component. In peanut allergy, 5 proteins are associated with clinical reactions of varying severity: Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9. Ara h1, Ara h 2, Ara h 3, and Ara h 9 are associated with severe symptoms whereas Ara h 8 is associated with much milder or no symptoms to peanut. This protein component of peanut is also linked to oral allergy syndrome, also known as pollen-food allergy syndrome. This syndrome is caused by cross-reacting allergens found in both pollen and raw fruits, vegetables, and/or some tree nuts. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it. People affected by oral allergy syndrome can usually eat the same fruits or vegetables in a cooked form because the proteins are denatured during the heating process, and the immune system no longer recognizes the food. Palforzia will come packaged in pull-apart capsules or sachets, to be mixed into age-appropriate foods such as applesauce or pudding.

The manufacturer is seeking FDA approval for Palforzia for use only in children between 4 and 17 years of age. In the clinical trials, the starting dose was 0.5 mg. of the product, gradually increasing to a maintenance dose of 600 mg. requiring about 8 biweekly visits to allergist’s office.
The new treatment will also likely carry a “black box” warning about possible anaphylaxis and a requirement to carry a self-injectable epinephrine device at all times.

It is likely that patients will need to continue therapy indefinitely, particularly in light of a recent study published online in Lancet on September 13, 2019. The study found that, in patients treated to a point where they could eat peanuts without incident, withdrawal of treatment led to waning tolerance over time. This implies that treatment may be life-long.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies for over 50 years. This new medication to treat peanut allergy is exciting and very promising. If this new medication is a success, we feel that there will be other drugs containing other food allergens such as fish, shellfish, milk, egg, wheat, and soy. This is of course pure speculation at this time, but it would make sense to develop other food-related OIT protocols, if Palforzia is successful.

The allergy doctors at Black & Kletz Allergy treat both adult and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan community for over 5 decades for our outstanding services for the diagnosis and treatment of allergic, asthmatic, and immunological conditions.

Alcohol Allergy and Intolerance

As allergy specialists Centreville, VA patients trust may attest, while it is possible to be allergic to alcoholic beverages, an alcohol allergy is relatively rare.  Most of the time, it is an intolerance and not an allergy to the alcohol that is bothersome to an individual.  An intolerance is basically an unwanted side effect of the alcohol.

True alcohol allergies can occur and generally are not an allergic reaction to the alcohol itself, but more likely an allergic reaction to an ingredient in the alcoholic beverage.  Some of the ingredients that may cause a true food allergy include barley, rye, wheat, corn, hops, grapes, egg, and yeast.  Symptoms can range from mild to life-threatening and can be the same symptoms that one experiences with alcohol intolerance (discussed below), which is why contacting an allergy specialist Centreville, VA has to offer may be crucial.

Most individuals that have reactions from drinking alcohol, however, have alcohol intolerance.  Some of the symptoms commonly associated with alcohol intolerance may include facial flushing, increased heart rate, nausea, vomiting, diarrhea, abdominal pain, headaches, nasal congestion, runny nose, sneezing, wheezing, shortness of breath, generalized itching (pruritus), hives (urticaria), swelling (angioedema), decreased blood pressure, and/or anaphylaxis.

If you speak to an allergy specialist in Centreville, VA, they might mention some of the following causes of alcohol intolerance which include:

  1. Sulfites:  Sulfites are put into most bottles of wine to act as a preservative. Note that one can buy sulfite-free wine, but the supply is much more limited than wines that contain sulfites.  Sulfites are found in many other foods, medications, and vaccines.  Many individuals are sensitive to sulfites and this preservative can cause hives, swelling, and even anaphylaxis in very sensitive individuals.  An estimated 5-10% of asthmatics have the propensity for sulfites to exacerbate their asthma.  Sulfites may be labeled as sodium metabisulfite, sodium bisulfite, sodium sulfite, potassium metabisulfite, potassium bisulfite, or sulfur dioxide (which technically is not a sulfite, but is a close relative).
  2. Inactivated Aldehyde Dehydrogenase:  Aldehyde dehydrogenase is an enzyme that breaks down alcohol to acetic acid (i.e., vinegar).  Some individuals have a genetic mutation that inactivates this enzyme which results in a flushed face and body during the consumption of alcohol.  They may also experience rapid heart rate, nausea, and/or headache.  In these people, alcohol is not broken down into acetic acid, and as a consequence, there is a build-up of acetaldehyde which is the cause of the flushing.  This mutation is more common in individuals of Asian descent as approximately 35% of East Asians have this condition and thus is sometimes referred to as “Asian flush syndrome.”  The gene change responsible for this mutation is thought to be linked with the domestication of rice, several hundreds of years ago in southern China.  The flushing syndrome is associated with a lower rate of alcoholism, probably due to the adverse effects when drinking alcohol, as well as an increase risk to esophageal cancer in those individuals who drink.
  3. Histamine:  Top allergy specialists Centreville, VA residents turn to should know that alcoholic drinks contain the chemical histamine, which is generated by the fermenting of yeast.  Histamine is released into the bloodstream in a normal allergic reaction and is attributable for many of the symptoms found in hay fever (allergic rhinitis).  Histamine found in alcoholic beverages are primarily responsible for the nasal congestion that one notices while drinking alcohol.
  4. An Underlying Medical Condition:  Hives and/or swelling can be exacerbated in patients with chronic hives (chronic urticaria) and/or swelling (angioedema).  Likewise, patients with Hodgkin’s lymphoma and other cancers are more likely to have alcohol-induced pain.  Individuals using medications such as Antabuse (i.e., disulfiram), Flagyl (i.e., metronidazole), and tinidazole (i.e., Tindamax, Fasigyn, Simplotan). Antabuse inhibits the enzyme, aldehyde dehydrogenase, thus causing the same flushing, increased heart rate, nausea, vomiting, and/or headaches found in the flushing syndrome mentioned above. Flagyl and Tindamax both are anti-parasitic medications and Flagyl is also used as an antibiotic.  Both of these medications interfere with the breakdown of alcohol and cause symptoms such as flushing, nausea, vomiting, abdominal pain, headaches, sweating, increased heart rate, decreased blood pressure, and liver damage.  Keep in mind that small amounts of alcohol (e.g., 1 tablespoon) are all that is needed to cause reactions when mixed with these medications.  Many over the counter oral and topical products contain alcohol such as colognes, aftershaves, cough syrups, mouthwashes, etc. and should be avoided while taking Flagyl and/or Tindamax.  There may also be other medications that should not be taken together with alcohol. As experienced allergy specialists Centreville, VA patients recommend highly, it is important to read the warnings on all prescription bottles from the pharmacy to ensure one’s safety.

Contact a Top Centreville, VA Allergy Specialist Today
If you have had an untoward reaction or side effect from consuming alcohol, please call the board certified allergists at Black & Kletz Allergy to schedule an appointment.  Food testing can be done to rule out an actual food allergy that is present in all alcoholic drinks.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 locations offer on-site parking.  In  addition, the Washington, DC and McLean, VA offices are Metro accessible with a free shuttle available that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been providing high quality allergy and asthma care to the DC metro community for more than a half century. If you have experienced alcohol allergies or intolerance, turn to allergy specialists Centreville, VA is proud to have in its community.

Food Allergy vs. Food Sensitivity (Food Intolerance) vs. Food Poisoning

Many people are convinced that they have food allergies.  For some, this is a correct assumption.  For others, they may actually have a food sensitivity or food intolerance, but not a true food allergy.  Still others, may have an episode of food poisoning.  In order for it to be a true food allergy, there must be a specific immune response to a particular food protein involving the immunoglobulin E (IgE) antibody (also known as the “allergy” antibody).  This type of reaction is called a Type I, IgE-mediated immunologic reaction.  The symptoms of a food allergy usually occur within seconds to a couple of hours after exposure to a food.

FOOD SENSITIVITY or FOOD INTOLERANCE:

A food sensitivity or food intolerance, on the other hand, is a non-immune toxic reaction against a food.  Unlike food allergies, the reaction usually occurs in a delayed fashion and typically develops between 1 hour and 3 days after eating the food.  It carries a much lower risk and is not as serious.  The food can affect different people in different ways.  Any organ system can be affected.  Since it can take days to develop symptoms, people with food sensitivities are difficult to diagnose and may go undiagnosed for many years.  One of the best ways to determine if someone has a food sensitivity is to do a food elimination diet and then add one food at a time back for several days to see if their symptoms re-occur.  If it does, then the individual should remove that food from their diet.  Some examples of food sensitivities and their cause are as follows:

  1. Gluten Intolerance – Inability to digest gluten (wheat, rye, and/or barley) or more recent research suggests that it may be the inability to digest FODMAP’s (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) rather than gluten.
  2. Lactose Intolerance – Deficiency of the enzyme “lactase” which normally breaks down the sugar lactose found in milk products.
  3. Favism (Glucose-6-phosphate dehydrogenase deficiency or G6PD deficiency) – Genetic deficiency in the enzyme G6PD causes anemia, fatigue, abdominal pain, headache, fever, etc. when these individuals eat fava beans or take certain medications (i.e., sulfonamides, certain anti-malarial drugs, aspirin, nitrofurantoin, dapsone, isoniazid).
  4. Adverse Reactions to Preservatives and/or Food Dyes – Some examples include sulfites, tartrazine, sodium benzoate, nitrates, nitrites, parabens, monosodium glutamate (MSG), aspartame, and butylated hydroxytoluene (BHT).
  5.  Pharmacologic Effect of Food – Some examples of chemicals found in a variety of foods include caffeine, tyramine, and histamine.

FOOD POISONING:

Food poisoning can mimic the symptoms of food allergies or food sensitivities.  Typically these symptoms of food poisoning can include diarrhea, abdominal pain, nausea, and/or vomiting.  Other symptoms more consistent with food poisoning than that of either food allergies or food sensitivities include fever, bloody diarrhea, blood in vomit, and/or general weakness.  The symptoms of food poisoning generally begin from a few hours to a few days after eating the affected food.  They typically last hours to a few days, but can last longer.  Often, other individuals eating the same food will exhibit similar symptoms which make the diagnosis of food poisoning more likely.  The causes of food poisoning most often include contamination with various bacteria, viruses, or parasites.  Other causes can include natural toxins (found naturally in many plants and some fish, etc.), other toxins that can arise from certain bacteria and fungi, and prions.  It is always highly recommended to wash one’s hands thoroughly before eating and avoid eating undercooked or raw meat, poultry, fish, shellfish, sprouts, or eggs  however, many cases of food poisoning are caused by poor sanitary conditions, spoilage, and/or improper food processing and/or storage of the food.  Travelers should also be extremely careful.  When in other countries, particularly third world countries, it is highly recommended to drink sealed bottled water, avoid ice and any food that has been washed or mixed with the local water (unless boiled and filtered), and avoid unpasteurized foods.  Dehydration is one of the most serious complications from a case of food poisoning.  It does not take long for a patient who has severe vomiting and/or diarrhea to become dehydrated.  It is therefore important to drink plenty of fluids in cases of food poisoning.  If symptoms last 2-3 days, one should seek medical care, so that the physician can obtain an appropriate history and perform a thorough physical examination.  The physician will order the appropriate blood work and obtain stool samples and cultures.  Treatment may include intravenous fluid and electrolyte replacement as well as antibiotics or anti-parasitic medication, if needed.

Note:  There is a food poisoning that can mimic an allergic reaction called “Scrombroid poisoning.”  The symptoms of this illness can include flushing and rash, rapid heart rate, lightheadedness/dizziness, headache, nausea, abdominal pain, and/or diarrhea.  In severe cases, one may experience shortness of breath, wheezing, swelling of the throat or tongue, and/or decreased blood pressure which can be life-threatening.  These symptoms all are typical of an allergic reaction, however, in scrombroid poisoning, there is no allergy and there is no contamination with bacteria, viruses, or parasites.  The cause of this condition is a chemical called histadine that is naturally occurring in some fish (i.e., tuna, bluefish, mahi mahi, mackerel, sardines, herring, anchovies).  When the fish is not properly stored, the fish spoils and certain bacteria grow and cause the histadine to convert to histamine.  It is the histamine (which is one of the main culprits in causing allergic reactions), that is the cause for the allergic symptoms found in scrombroid poisoning. Treatment of mild symptoms can be treated with antihistamines, however, if symptoms become more severe or they become prolonged, one should go to the closest emergency room for treatment.

FOOD ALLERGIES:

Symptoms:

The symptoms of food allergies can be diverse.  Some of the more common symptoms found with food allergies include:  generalized itching (pruritus), itchy mouth and/or throat, hives (urticaria), other rashes, abdominal pain, diarrhea, vomiting, wheezing, shortness of breath, swelling (angioedema) , throat tightening, and/or anaphylaxis.  As mentioned above, the symptoms usually occur within seconds to a couple of hours after exposure to the food.  They can be very mild or very severe and life threatening.  The most common foods associated with life-threatening reactions from foods include:  peanuts, tree nuts, fish, and/or shellfish.

Most Common Food Allergies:

The most common food allergies in infants and children are milk, egg, soy, wheat, peanuts, and tree nuts. In adults, the most common food allergies are fish, shellfish, peanuts, and tree nuts.  It should be noted that anyone can be allergic to any food.  That food can cause symptoms ranging from very mild to very severe life-threating reactions.

Food protein-induced enterocolitis syndrome (FPIES):

Food protein-induced enterocolitis syndrome is a type of food allergy which usually affects infants and babies.  The cause of the syndrome is usually due to a food, most commonly cow’s milk formula and soy-based formula.  Breast milk may also contain food proteins that can cause this condition, however, this is rare.  Other foods commonly associated with this syndrome can include oats, rice, sweet potatoes, squash, chicken, turkey, peas, green beans, and fish.  Symptoms include vomiting and diarrhea (occasionally with blood), dehydration, weight loss, and failure to thrive.  It is typical, however, for the symptoms to begin several hours after the food is consumed.  This delay in symptoms makes it more difficult for this condition to be diagnosed.  The diagnosis is further complicated by the fact that usual skin and blood testing done for food allergies usually are not be positive.  Once the diagnosis is established, the food should be eliminated from the infant’s diet and alternative foods should be consumed.  It is usually necessary to see a board certified allergist to diagnose this often “difficult to diagnose” problem.

Diagnosis and Treatment:

If one suspects food allergies, one should seek a board certified allergist.  The allergists at Black & Kletz Allergy have had over 50 years of experience in diagnosing and managing food allergies and sensitivities in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Food allergies can be diagnosed by a thorough history and physical examination along with prick skin testing and/or blood testing. The management varies but in most instances, avoidance of the food is the recommended treatment.  If you feel that you may e an issue with food allergies or sensitivities, we would be happy to see you in one of our 3 convenient locations with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Please feel free to call our office or alternatively, you may click Request an Appointment and we will respond within 24 hours on the next business day. Black & Kletz Allergy is proud to provide quality allergy and immunology care in a relaxed caring environment.